Journal of Clinical Medicine

Editorial

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Open AccessEditorial

Innovations in the Realm of Shoulder Arthroplasty

by Alexandre Lädermann, Laurent Audigé and Markus Scheibel

J. Clin. Med. 2023, 12(1), 237; https://doi.org/10.3390/jcm12010237 - 28 Dec 2022

Viewed by 1433

Abstract

Most of the surgeries regarding the shoulder were established over a century ago [...] Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

Research

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13 pages, 2321 KiB

Open AccessArticle

Clinical and Radiologic Outcomes after Anatomical Total Shoulder Replacement Using a Modular Metal-Backed Glenoid after a Mean Follow-Up of 5.7 Years

by Emil Noschajew, Felix Rittenschober, Harald Kindermann and Reinhold Ortmaier

J. Clin. Med. 2022, 11(20), 6107; https://doi.org/10.3390/jcm11206107 - 17 Oct 2022

Cited by 3 | Viewed by 2242

Abstract

Background: Glenoid wear is a common complication of anatomical total shoulder arthroplasty (aTSA) with a metal-backed glenoid (MBG), and the clinical and radiological results of historical implants are poor. The aim of this work was to evaluate the clinical and radiological results of [...] Read more.

Background: Glenoid wear is a common complication of anatomical total shoulder arthroplasty (aTSA) with a metal-backed glenoid (MBG), and the clinical and radiological results of historical implants are poor. The aim of this work was to evaluate the clinical and radiological results of 25 participants as well as the longevity after implantation of an anatomic shoulder prosthesis with a recent, modular cementless flat metal-backed glenoid component after a mean follow-up of 5.7 years. Methods: Clinically, the Simple Shoulder Test (SST), UCLA Activity Score (UCLA), and Constant Murley Score (CMS) were evaluated. Radiographically, the radiolucent lines (RLs), humeral head migration (HHM), and lateral glenohumeral offset (LGHO) were assessed. Survival was calculated with Kaplan–Meier curves and life-table analysis. Results: The mean CMS at follow-up was 46.2 points (range: 14–77; SD: 19.5). In terms of the SST score, the average value was 6.5 points (range: 1–10; SD: 3.5). The UCLA activity score showed a mean value of 5.9 points (range: 1–9; SD: 2.1). There were 17 revisions after a mean follow-up of 68.2 months (range: 1.8–119.6; SD: 27.9). HHM occurred in every patient, with a mean measurement of 6.4 mm (range: 0.5–13.4; SD: 3.9; p < 0.0001). The mean LGHO between the initial postoperative and follow-up images was 2.6 mm (range: 0–4.0; SD: 1.5; p < 0.0001). RLs were found in 22 patients (88%) around the glenoid and in 21 patients (84%) around the humeral head prosthesis. Conclusion: The clinical and radiographic outcomes after metal-backed glenoids were poor at 2.2 to 8.4 years of follow-up. We determined devastating survival in the majority of cases (68%), with mostly inlay wear (71%) as the main reason that led to revision surgery. The use of metalback genoids cannot be recommended based on the data of this study. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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10 pages, 4664 KiB

Open AccessArticle

Inverted-Bearing Reverse Shoulder Arthroplasty: Consequences on Scapular Notching and Clinical Results at Mid-Term Follow-Up

by Alessandro Castagna, Mario Borroni, Luigi Dubini, Stefano Gumina, Giacomo Delle Rose and Riccardo Ranieri

J. Clin. Med. 2022, 11(19), 5796; https://doi.org/10.3390/jcm11195796 - 29 Sep 2022

Cited by 9 | Viewed by 2117

Abstract

Background: Scapular notching following reverse shoulder arthroplasty (RSA) is caused by both biological and mechanical mechanisms. Some authors postulated that osteolysis that extends over the inferior screw is caused mainly by biological notching. Inverted-bearing RSA (IB-RSA) is characterized by a polyethylene glenosphere and [...] Read more.

Background: Scapular notching following reverse shoulder arthroplasty (RSA) is caused by both biological and mechanical mechanisms. Some authors postulated that osteolysis that extends over the inferior screw is caused mainly by biological notching. Inverted-bearing RSA (IB-RSA) is characterized by a polyethylene glenosphere and a metallic humeral liner, decreasing the poly debris formation and potentially reducing high grades of notching. This study aims to report the results of IB-RSA on a consecutive series of patients at mid-term follow-up, focusing on the incidence of Sirveaux grade 3 and 4 scapular notching. Methods: A retrospective study on 78 consecutive patients who underwent primary IB-RSA between 2015–2017 was performed. At a 4 years minimum follow-up, 49 patients were evaluated clinically with Constant score (CS), Subjective shoulder value (SSV), American Shoulder and Elbow score (ASES), pain and range of motion, and with an X-ray assessing baseplate position (high, low), implant loosening, and scapular notching. Results: At a mean follow-up of 5.0 ± 0.9, all the clinical parameters improved (p < 0.05). One patient was revised for an infection and was excluded from the evaluation, two patients had an acromial fracture, and one had an axillary neuropraxia. Scapular notching was present in 13 (27%) patients (six grade 1, seven grade 2) and no cases of grade 3 and 4 were observed. Scapular nothing was significantly associated with high glenoid position (p < 0.001) and with lower CS (70 ± 15 vs. 58 ± 20; p = 0.046), SSV (81 ± 14 vs. 68 ± 20; p = 0.027), ASES (86 ± 14 vs. 70 ± 22; p = 0.031), and anterior elevation (148 ± 23 vs. 115 ± 37; p = 0.006). A 44 mm- compared to 40 mm-glenosphere was associate with better CS (63 ± 17 vs. 78 ± 11; p = 0.006), external (23 ± 17 vs. 36 ± 17; p = 0.036), and internal rotation (4.8 ± 2.7 vs. 7.8 ± 2.2; p = 0.011). Conclusions: IB-RSA is a safe and effective procedure for mid-term follow-up. Inverting biomaterials leads to a distinct kind of notching with mainly mechanical features. Scapular notching is associated with a high baseplate position and has a negative influence on range of motion and clinical outcome. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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14 pages, 2527 KiB

Open AccessArticle

Implant Sizing and Positioning in Anatomical Total Shoulder Arthroplasty Using a Rotator Cuff-Sparing Postero-Inferior Approach

by Philipp Moroder, Lucca Lacheta, Marvin Minkus, Katrin Karpinski, Frank Uhing, Sheldon De Souza, Michael van der Merwe and Doruk Akgün

J. Clin. Med. 2022, 11(12), 3324; https://doi.org/10.3390/jcm11123324 - 10 Jun 2022

Cited by 1 | Viewed by 2634

Abstract

Background: The goal of this study was to compare the effectiveness of a rotator cuff-sparing postero-inferior (PI) approach with subdeltoidal access to the traditional subscapularis-takedown deltopectoral approach, in terms of implant sizing and positioning in anatomical total shoulder arthroplasty (aTSA). Methods: This study [...] Read more.

Background: The goal of this study was to compare the effectiveness of a rotator cuff-sparing postero-inferior (PI) approach with subdeltoidal access to the traditional subscapularis-takedown deltopectoral approach, in terms of implant sizing and positioning in anatomical total shoulder arthroplasty (aTSA). Methods: This study involved 18 human cadaveric shoulders with intact rotator cuffs and no evidence of head deforming osteoarthritis. An Eclipse stemless aTSA (Arthrex, Naples, FL, USA) was implanted in nine randomly selected specimens using a standard subscapularis-tenotomy deltopectoral approach, and in the other nine specimens using the cuff-sparing PI approach. Pre- and postoperative antero-posterior (AP) and axillary fluoroscopic radiographs were analyzed by two independent, blinded raters for the following parameters: (1) anatomic and prosthetic neck-shaft angle (NSA); (2) the shift between the anatomic and prosthetic center of rotation (COR); (3) anatomical size matching of the prosthetic humeral head; (4) the calculated Anatomic Reconstruction Score (ARS); (5) glenoid positioning; as well as (6) glenoid inclination and version. Results: While the COR was slightly but significantly positioned (p = 0.031) to be more medial in the PI approach group (3.7 ± 3.4%, range: −2.3% to 8.7%) than in the deltopectoral approach group (−0.2 ± 3.6%, range: −6.9% to 4.1%), on average, none of the remaining measured radiographic parameters significantly differed between both groups (PI approach group vs. deltopectoral group: NSA 130° vs. 127°, p = 0.57; COR supero-inferior, 2.6% vs. 1.0%, p = 0.35; COR antero-posterior, 0.9% vs. 1.7%, p = 0.57; head size supero-inferior, 97.3% vs. 98.5%, p = 0.15; head size antero-posterior, 101.1% vs. 100.6%, p = 0.54; ARS, 8.4 vs. 9.3, p = 0.13; glenoid positioning supero-inferior, 49.1% vs. 51.1%, p = 0.33; glenoid positioning antero-posterior, 49.3% vs. 50.4%, p = 0.23; glenoid inclination, 86° vs. 88°, p = 0.27; and glenoid retroversion, 91° vs. 89°, p = 0.27). Conclusions: A PI approach allows for sufficient exposure and orientation to perform rotator-cuff sparing aTSA with acceptable implant sizing and positioning in cadaveric specimens. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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11 pages, 1277 KiB

Open AccessArticle

Reverse Shoulder Arthroplasty for Proximal Humerus Head-Split Fractures—A Retrospective Cohort Study

by Jan-Philipp Imiolczyk, Ulrich Brunner, Tankred Imiolczyk, Florian Freislederer, David Endell and Markus Scheibel

J. Clin. Med. 2022, 11(10), 2835; https://doi.org/10.3390/jcm11102835 - 17 May 2022

Cited by 7 | Viewed by 3041

Abstract

Head-split fractures are proximal humerus fractures (PHF) that result from fracture lines traversing the articular surface. While head-split fractures are rare, surgical treatment of these complex injuries can be extremely challenging and is associated with high rates of complications. Treatment using primary reverse [...] Read more.

Head-split fractures are proximal humerus fractures (PHF) that result from fracture lines traversing the articular surface. While head-split fractures are rare, surgical treatment of these complex injuries can be extremely challenging and is associated with high rates of complications. Treatment using primary reverse shoulder arthroplasty (RSA) has been associated with moderate complication rates and reproducible clinical results. The aim of this study was to evaluate clinical and radiographic outcomes, and complication rates of RSA for head-split PHF. Twenty-six patients were evaluated based on Constant Score (CS) and range of motion of both shoulders and Subjective Shoulder Value (SSV). Radiographic analysis evaluated tuberosity healing, prosthetic loosening and scapular notching. Patients achieved good clinical results with a CS of 73.7 points and SSV of 82% after a mean follow-up of 50 months. The relative CS comparing operated versus the unaffected shoulder was 92%. Greater tuberosity healing was achieved in 61%. Patients who suffered a high-energy trauma reached a significantly greater functional outcome. Patients who suffered multifragmentation to the humeral head performed the worst. There were no cases of loosening; scapular notching was visible in two cases. The complication rate was 8%. RSA is an adequate treatment option with for head-split PHF in elderly patients. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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9 pages, 2297 KiB

Open AccessArticle

Conversion of Hemiarthroplasty to Reverse Shoulder Arthroplasty with Humeral Stem Retention

by Falk Reuther, Ulrich Irlenbusch, Max J. Kääb and Georges Kohut

J. Clin. Med. 2022, 11(3), 834; https://doi.org/10.3390/jcm11030834 - 4 Feb 2022

Cited by 6 | Viewed by 2441

Abstract

The purpose of this study is to evaluate the mid-term clinical results of an ongoing case series on conversion reverse shoulder arthroplasty (RSA) with a modular prosthesis system. We included 17 elderly patients revised for failed hemiarthroplasty after proximal humeral fracture, of which [...] Read more.

The purpose of this study is to evaluate the mid-term clinical results of an ongoing case series on conversion reverse shoulder arthroplasty (RSA) with a modular prosthesis system. We included 17 elderly patients revised for failed hemiarthroplasty after proximal humeral fracture, of which 13 were converted using a modular reverse shoulder prosthesis. Four could not be converted due to overstuffing. For the conversion RSA, we determined the Constant score, American Shoulder and Elbow Surgeons Shoulder Score, visual analogue scale for pain and satisfaction, and range of motion preoperatively, at one year, and at the last follow-up. All measured clinical outcomes improved significantly at both follow-up time points (p < 0.05). The mean duration of surgery was 118.4 min (range: 80.0 to 140.0 min). We observed complications in three patients; these included one late infection and two aseptic stem loosenings. Modular shoulder arthroplasty is a suitable procedure for conversion RSA in elderly patients. All measured postoperative clinical outcomes improved significantly, the complication rate was acceptable, and no prosthesis-related complications occurred. Conversion RSA, although not feasible in every case, is a viable treatment option in the elderly, which can provide successful mid-term results. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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11 pages, 435 KiB

Open AccessArticle

Shoulder Replacement in the Elderly with Anatomic versus Reverse Total Prosthesis? A Prospective 2-Year Follow-Up Study

by Maciej J. K. Simon, Jennifer A. Coghlan and Simon N. Bell

J. Clin. Med. 2022, 11(3), 540; https://doi.org/10.3390/jcm11030540 - 21 Jan 2022

Cited by 3 | Viewed by 2524

Abstract

Background: In older patients requiring a total shoulder replacement (TSR) and with an intact rotator cuff, there is currently uncertainty on whether an anatomic TSR (aTSR) or a reverse TSR (rTSR) is best for the patient. This comparison study of same-aged patients aims [...] Read more.

Background: In older patients requiring a total shoulder replacement (TSR) and with an intact rotator cuff, there is currently uncertainty on whether an anatomic TSR (aTSR) or a reverse TSR (rTSR) is best for the patient. This comparison study of same-aged patients aims to assess clinical and radiological outcomes of older patients (≥75 years) who received either an aTSR or an rTSR. Methods: Consecutive patients with a minimum age of 75 years who received an aTSR (n = 44) or rTSR (n = 51) were prospectively studied. Pre- and post-operative clinical evaluations included the ASES score, Constant score, SPADI score, DASH score, range of motion (ROM) and pain and patient satisfaction for a follow-up of 2 years. Radiological assessment identified glenoid and humeral component osteolysis, including notching with an rTSR. Results: We found postoperative improvement for ROM and all clinical assessment scores for both groups. There were significantly better patient reported outcome scores (PROMs) in the aTSR group compared with the rTSR patients (p < 0.001). Both groups had only minor osteolysis on radiographs. No revisions were required in either group. The main complications were scapular stress fractures for the rTSR (n = 11) patients and acromioclavicular joint pain for both groups (aTSR = 2; rTSR = 6). Conclusions: This study of older patients (≥75 years) demonstrated that an aTSR for a patient with good rotator cuff muscles can lead to a better clinical outcome and less early complications than an rTSR. Level of evidence: Level II—prospective cohort study. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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11 pages, 871 KiB

Open AccessArticle

Association of the Posterior Acromion Extension with Glenoid Retroversion: A CT Study in Normal and Osteoarthritic Shoulders

by Alexandre Terrier, Fabio Becce, Frédéric Vauclair, Alain Farron and Patrick Goetti

J. Clin. Med. 2022, 11(2), 351; https://doi.org/10.3390/jcm11020351 - 12 Jan 2022

Cited by 3 | Viewed by 2132

Abstract

Posterior eccentric glenoid wear is associated with higher complication rates after shoulder arthroplasty. The recently reported association between the acromion shape and glenoid retroversion in both normal and osteoarthritic shoulders remains controversial. The three-dimensional coordinates of the angulus acromialis (AA) and acromioclavicular joint [...] Read more.

Posterior eccentric glenoid wear is associated with higher complication rates after shoulder arthroplasty. The recently reported association between the acromion shape and glenoid retroversion in both normal and osteoarthritic shoulders remains controversial. The three-dimensional coordinates of the angulus acromialis (AA) and acromioclavicular joint were examined in the scapular coordinate system. Four acromion angles were defined from these two acromion landmarks: the acromion posterior angle (APA), acromion tilt angle (ATA), acromion length angle (ALA), and acromion axial tilt angle (AXA). Shoulder computed tomography scans of 112 normal scapulae and 125 patients with primary glenohumeral osteoarthritis were analyzed with simple and stepwise multiple linear regressions between all morphological acromion parameters and glenoid retroversion. In normal scapulae, the glenoid retroversion angle was most strongly correlated with the posterior extension of the AA (R² = 0.48, p < 0.0001), which can be conveniently characterized by the APA. Combining the APA with the ALA and ATA helped slightly improve the correlation (R² = 0.55, p < 0.0001), but adding the AXA did not. In osteoarthritic scapulae, a critical APA > 15 degrees was found to best identify glenoids with a critical retroversion angle > 8 degrees. The APA is more strongly associated with the glenoid retroversion angle in normal than primary osteoarthritic scapulae. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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9 pages, 1224 KiB

Open AccessArticle

Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

by Jaroslaw Pecold, Mahdi Al-Jeabory, Maciej Krupowies, Ewa Manka, Adam Smereka, Jerzy Robert Ladny and Lukasz Szarpak

J. Clin. Med. 2022, 11(1), 48; https://doi.org/10.3390/jcm11010048 - 23 Dec 2021

Cited by 16 | Viewed by 2787

Abstract

Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis [...] Read more.

Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= −0.15; 95%CI: −0.23 to −0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= −0.51; 95%CI: −0.57 to −0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= −1.43; 95%CI: −2.27 to −0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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6 pages, 855 KiB

Open AccessArticle

COVID-19 as a Catalyst for Same-Day Discharge Total Shoulder Arthroplasty

by Mariano E. Menendez, Noah Keegan, Brian C. Werner and Patrick J. Denard

J. Clin. Med. 2021, 10(24), 5908; https://doi.org/10.3390/jcm10245908 - 16 Dec 2021

Cited by 13 | Viewed by 1931

Abstract

The COVID-19 pandemic caused major disruptions to the healthcare system, but its impact on the transition to same-day discharge shoulder arthroplasty remains unexplored. This study assessed the effect of COVID-19 on length of stay (LOS), same-day discharge rates, and other markers of resource [...] Read more.

The COVID-19 pandemic caused major disruptions to the healthcare system, but its impact on the transition to same-day discharge shoulder arthroplasty remains unexplored. This study assessed the effect of COVID-19 on length of stay (LOS), same-day discharge rates, and other markers of resource use after elective total shoulder arthroplasty. A total of 508 consecutive patients undergoing elective primary total shoulder arthroplasty between 2019 and 2021 were identified and divided into 2 cohorts: “pre-COVID” (March 2019–March 2020; n = 263) and “post-COVID” (May 2020–March 2021; n = 245). No elective shoulder arthroplasties were performed at our practice between 18 March and 11 May 2020. Outcome measures included LOS, same-day discharge, discharge location, and 90-day emergency department (ED) visits, readmissions and reoperations. There were no significant differences in baseline preoperative patient characteristics. Shoulder arthroplasty performed post-COVID was associated with a shorter LOS (12 vs. 16 h, p = 0.017) and a higher rate of same-day discharge (87.3 vs. 79.1%, p = 0.013). The rate of discharge to skilled nursing facilities was similarly low between the groups (1.9 vs. 2.0%, p = 0.915). There was a significant reduction in the rate of 90-day ED visits post-COVID (7.4 vs. 13.3%, p = 0.029), while there were no differences in 90-day reoperation (2.0 vs. 1.5%, p = 0.745) or readmission rates (1.2 vs. 1.9%, p = 0.724). The COVID-19 pandemic seems to have accelerated the shift towards shorter stays and more same-day discharge shoulder arthroplasties, while reducing unexpected acute health needs (e.g., ED visits) without adversely affecting readmission and reoperation rates. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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11 pages, 1408 KiB

Open AccessArticle

Measuring Patient Value after Total Shoulder Arthroplasty

by Alexandre Lädermann, Rodolphe Eurin, Axelle Alibert, Mehdi Bensouda and Hugo Bothorel

J. Clin. Med. 2021, 10(23), 5700; https://doi.org/10.3390/jcm10235700 - 4 Dec 2021

Cited by 4 | Viewed by 1957

Abstract

Evaluating the value of health care is of paramount importance to keep improving patients’ quality of life and optimizing associated costs. Our objective was to present a calculation method based on Michael Porter’s formula and standard references to estimate patient value delivered by [...] Read more.

Evaluating the value of health care is of paramount importance to keep improving patients’ quality of life and optimizing associated costs. Our objective was to present a calculation method based on Michael Porter’s formula and standard references to estimate patient value delivered by total shoulder arthroplasty (TSA). We retrospectively reviewed the records of 116 consecutive TSAs performed between June 2015 and June 2019. Patient value was defined as quality of care divided by direct costs of surgery. Quality metrics included intra- and postoperative complications as well as weighted improvements in three different patient-reported outcome measures at a minimum of one-year follow-up. Direct costs of surgery were retrieved from the management accounting analyses. Substantial clinical benefit (SCB) thresholds and the standard reimbursement system were used as references for quality and cost dimensions. A multivariable linear regression was performed to identify factors associated with patient delivered value. Compared to a reference of 1.0, the quality of care delivered to patients was 1.3 ± 0.3 (range, 0.6–2.0) and the associated direct cost was 1.0 ± 0.2 (range, 0.7–1.6). Ninety patients (78%) had a quality of care ≥1.0 and 61 patients (53%) had direct costs related to surgery ≤1.0. The average value delivered to patients was 1.3 ± 0.4 (range, 0.5–2.5) with 91 patients (78%) ≥ 1.0, was higher for non-smokers (beta, 0.12; p = 0.044), anatomic TSA (beta, 0.53; p < 0.001), increased with higher pre-operative pain (beta, 0.08; p < 0.001) and lower pre-operative Constant score (beta, −0.06; p = 0.001). Our results revealed that almost 80% of TSAs provided substantial patient value. Patient pre-operative pain/function, tobacco use, and procedure type are important factors associated with delivered patient value. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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13 pages, 3520 KiB

Open AccessArticle

Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study

by Marko Nabergoj, Lionel Neyton, Hugo Bothorel, Sean W. L. Ho, Sidi Wang, Xue Ling Chong and Alexandre Lädermann

J. Clin. Med. 2021, 10(22), 5274; https://doi.org/10.3390/jcm10225274 - 13 Nov 2021

Cited by 11 | Viewed by 3096

Abstract

There are different techniques to address severe glenoid erosion during reverse shoulder arthroplasty (RSA). This study assessed the clinical and radiological outcomes of RSA with combined bony and metallic augment (BMA) glenoid reconstruction compared to bony augmentation (BA) alone. A review of patients [...] Read more.

There are different techniques to address severe glenoid erosion during reverse shoulder arthroplasty (RSA). This study assessed the clinical and radiological outcomes of RSA with combined bony and metallic augment (BMA) glenoid reconstruction compared to bony augmentation (BA) alone. A review of patients who underwent RSA with severe glenoid bone loss requiring reconstruction from January 2017 to January 2019 was performed. Patients were divided into two groups: BMA versus BA alone. Clinical outcome measurements included two years postoperative ROM, Constant score, subjective shoulder value (SSV), and the American Shoulder and Elbow Surgeons Shoulder (ASES) score. Radiological outcomes included radiographic evidence of scapular complications and graft incorporation. The BMA group had significantly different glenoid morphology (p < 0.001) and greater bone loss thickness than the BA group (16.3 ± 3.8 mm vs. 12.0 ± 0.0 mm, p = 0.020). Both groups had significantly improved ROM (anterior forward flexion and external rotation) and clinical scores (Constant, SSV and ASES scores) at 2 years. Greater improvement was observed in the BMA group in terms of anterior forward flexion (86.3° ± 27.9° vs. 43.8° ± 25.6°, p = 0.013) and Constant score (56.6 ± 10.1 vs. 38.3 ± 16.7, p = 0.021). The BA group demonstrated greater functional and clinical improvements with higher postoperative active external rotation and ASES results (active external rotation, 49.4° ± 17.0° vs. 29.4° ± 14.7°, p = 0.017; ASES, 89.1 ± 11.3 vs. 76.8 ± 11.0, p = 0.045). The combination use of bone graft and metallic augments in severe glenoid bone loss during RSA is safe and effective and can be considered in cases of severe glenoid bone loss where bone graft alone may be insufficient. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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9 pages, 249 KiB

Open AccessArticle

Two-Stage Exchange Arthroplasty for Periprosthetic Shoulder Infection Is Associated with High Rate of Failure to Reimplant and Mortality

by Doruk Akgün, Mats Wiethölter, Nina Maziak, Alp Paksoy, Daniel Karczewski, Markus Scheibel and Philipp Moroder

J. Clin. Med. 2021, 10(21), 5186; https://doi.org/10.3390/jcm10215186 - 6 Nov 2021

Cited by 10 | Viewed by 2127

Abstract

Background: Patients with a periprosthetic joint infection (PJI) of the shoulder, who fail to undergo reimplantation in an attempted two-stage exchange seem to be neglected in the current literature. The aim of this study was to assess the clinical course of patients after [...] Read more.

Background: Patients with a periprosthetic joint infection (PJI) of the shoulder, who fail to undergo reimplantation in an attempted two-stage exchange seem to be neglected in the current literature. The aim of this study was to assess the clinical course of patients after the first stage in the process of an attempted two-stage exchange for shoulder PJI. Methods: After a retrospective review of our institutional database between 2008 and 2018, 49 patients, who were treated with an intended two-stage exchange for shoulder PJI, were identified. Patients’ demographics, laboratory and health status parameters, along with records of clinical outcome were collected. The primary outcome measurements analyzed were infection eradication, successful reimplantation, and patient survival. Results: Reimplantation was completed in only 35 (71%) of 49 cases and eradication of infection was achieved in 85.7% of patients with successful reimplantation after a mean follow-up duration of 5.1 years (1.1 to 10.2 years). Reasons for failure to reimplant were premature death in 36%, high general morbidity in 29%, satisfaction with the current status in 21%, or severe infection with poor bone and soft tissues in 14% of the patients. Of the 14 cases without reimplantation, eradication rate of infection was 57% after a mean follow-up of 5 years (2.6 to 11 years). The overall mortality rate of the entire cohort was 25% at the latest follow-up and 10% within ninety days after implant removal. Patients who deceased or did not undergo reimplantation during the follow-up were significantly older and had a significantly higher Charlson comorbidity index (CCI). Conclusions: While the two-stage exchange arthroplasty can lead to high rates of infection eradication, a considerable subset of patients never undergoes the second stage for a variety of reasons. Shoulder PJI and its treatment are associated with a high risk of mortality, especially in patients with older age and higher CCI. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

14 pages, 1220 KiB

Open AccessArticle

Projections of Primary and Revision Shoulder Arthroplasty until 2040: Facing a Massive Rise in Fracture-Related Procedures

by Alexander Klug, Eva Herrmann, Sebastian Fischer, Reinhard Hoffmann and Yves Gramlich

J. Clin. Med. 2021, 10(21), 5123; https://doi.org/10.3390/jcm10215123 - 31 Oct 2021

Cited by 25 | Viewed by 2407

Abstract

Although the demand for shoulder arthroplasties has reached its highest number worldwide, there remains a lack of epidemiologic data regarding recent and future trends. In this study, data for all shoulder arthroplasties (hemiarthroplasty, reverse/anatomic shoulder arthroplasty) from the nationwide inpatient statistics of Germany [...] Read more.

Although the demand for shoulder arthroplasties has reached its highest number worldwide, there remains a lack of epidemiologic data regarding recent and future trends. In this study, data for all shoulder arthroplasties (hemiarthroplasty, reverse/anatomic shoulder arthroplasty) from the nationwide inpatient statistics of Germany (2010–2019) and population forecasts until 2040 were gathered. A Poisson and a negative binomial approach using monotone B-splines were modeled for all types of prostheses to project the annual number and incidence of primary and revision arthroplasty. Additionally, trends in main indicators were also gathered and expected changes were calculated. Overall, the number of primary shoulder replacements is set to increase significantly by 2040, reaching at least 37,000 (95% CI 32,000–44,000) procedures per year. This trend is mainly attributable to an about 10-fold increased use of fracture-related reverse shoulder arthroplasty in patients over 80 years of age, although the number of procedures in younger patients will also rise substantially. In contrast, hemiarthroplasties will significantly decrease. The number of revision procedures is projected to increase subsequently, although the revision burden is forecast to decline. Using these country-specific projection approaches, a massive increase of primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures. These growth rates are substantially higher than those from hip or knee arthroplasty. As these trends are similar in most Western countries, this draws attention to the international issue, of: if healthcare systems will be able to allocate human and financial resources adequately, and if future research and fracture-prevention programs may help to temper this rising burden in the upcoming decades. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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8 pages, 623 KiB

Open AccessArticle

Can Lateralization of Reverse Shoulder Arthroplasty Improve Active External Rotation in Patients with Preoperative Fatty Infiltration of the Infraspinatus and Teres Minor?

by Marko Nabergoj, Shinzo Onishi, Alexandre Lädermann, Houssam Kalache, Rihard Trebše, Hugo Bothorel and Philippe Collin

J. Clin. Med. 2021, 10(18), 4130; https://doi.org/10.3390/jcm10184130 - 13 Sep 2021

Cited by 15 | Viewed by 3971

Abstract

(1) Background: Postoperative recovery of external rotation after reverse shoulder arthroplasty (RSA) has been reported despite nonfunctional external rotator muscles. Thus, this study aimed to clinically determine the ideal prosthetic design allowing external rotation recovery in such a cohort. (2) Methods: A monocentric [...] Read more.

(1) Background: Postoperative recovery of external rotation after reverse shoulder arthroplasty (RSA) has been reported despite nonfunctional external rotator muscles. Thus, this study aimed to clinically determine the ideal prosthetic design allowing external rotation recovery in such a cohort. (2) Methods: A monocentric comparative study was retrospectively performed on patients who had primary RSA between June 2013 and February 2018 with a significant preoperative fatty infiltration of the infraspinatus and teres minor. Two groups were formed with patients with a lateral humerus/lateral glenoid 145° onlay RSA—the onlay group (OG), and a medial humerus/lateral glenoid 155° inlay RSA—the inlay group (IG). Patients were matched 1:1 by age, gender, indication, preoperative range of motion (ROM), and Constant score. The ROM and Constant scores were assessed preoperatively and at a minimum follow-up of two years. (3) Results: Forty-seven patients have been included (23 in OG and 24 in IG). Postoperative external rotation increased significantly in the OG only (p = 0.049), and its postoperative value was significantly greater than that of the IG by 11.1° (p = 0.028). (4) Conclusion: The use of a lateralized humeral stem with a low neck-shaft angle resulted in significantly improved external rotation compared to a medialized humeral 155° stem, even in cases of severe fatty infiltration of the infraspinatus and teres minor. Humeral lateralization and a low neck-shaft angle should be favored when planning an RSA in a patient without a functional posterior rotator cuff. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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9 pages, 22028 KiB

Open AccessArticle

Clinical and Radiological Results of Hemiarthroplasty and Total Shoulder Arthroplasty for Primary Avascular Necrosis of the Humeral Head in Patients Less Than 60 Years Old

by Anthony Hervé, Mickael Chelli, Pascal Boileau, Gilles Walch, Luc Favard, Christophe Levigne, François Sirveaux, Philippe Clavert, Nicolas Bonnevialle and Philippe Collin

J. Clin. Med. 2021, 10(14), 3081; https://doi.org/10.3390/jcm10143081 - 12 Jul 2021

Cited by 7 | Viewed by 2633

Abstract

Background: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) have shown good clinical outcomes in primary avascular necrosis of the humeral head (PANHH) both in short and long terms. The purpose of this study was to assess the complications, the clinical and radiological outcomes [...] Read more.

Background: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) have shown good clinical outcomes in primary avascular necrosis of the humeral head (PANHH) both in short and long terms. The purpose of this study was to assess the complications, the clinical and radiological outcomes of shoulder arthroplasty in young patients with PANHH. Methods: One hundred and twenty-seven patients aged under 60 years old and suffering from PANHH were operated with arthroplasty. Patients were assessed clinically and radiographically before surgery with a minimum of 2 years of follow up (FU). Results: HA was performed on 108 patients (85%). Two patients were revised for painful glenoid wear after 2 and 4 years. TSA was performed on 19 patients (15%). Five TSA had to be revised for glenoid loosening (n = 4) or instability (n = 1). Revision rate was 26% with TSA and 2% with HA. There were no significant differences between HA and TSA in terms of clinical outcomes. Conclusions: With a mean FU of 8 years, HA and TSA improved clinical outcomes of patients with PANHH. HA revisions for painful glenoid wear were rare (2%). The revision rate was excessively high with TSA (26%). Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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13 pages, 3931 KiB

Open AccessArticle

Negligible Correlation between Radiographic Measurements and Clinical Outcomes in Patients Following Primary Reverse Total Shoulder Arthroplasty

by Daniel P. Berthold, Daichi Morikawa, Lukas N. Muench, Joshua B. Baldino, Mark P. Cote, R. Alexander Creighton, Patrick J. Denard, Reuben Gobezie, Evan Lederman, Anthony A. Romeo, Knut Beitzel and Augustus D. Mazzocca

J. Clin. Med. 2021, 10(4), 809; https://doi.org/10.3390/jcm10040809 - 17 Feb 2021

Cited by 24 | Viewed by 3443

Abstract

Previous attempts to measure lateralization, distalization or inclination after reverse total shoulder arthroplasty (rTSA) and to correlate them with clinical outcomes have been made in the past years. However, this is considered to be too demanding and challenging for daily clinical practice. Additionally, [...] Read more.

Previous attempts to measure lateralization, distalization or inclination after reverse total shoulder arthroplasty (rTSA) and to correlate them with clinical outcomes have been made in the past years. However, this is considered to be too demanding and challenging for daily clinical practice. Additionally, the reported findings were obtained from heterogeneous rTSA cohorts using 145° and 155° designs and are limited in external validity. The purpose of this study was to investigate the prognostic preoperative and postoperative radiographic factors affecting clinical outcomes in patients following rTSA using a 135° prosthesis design. In a multi-center design, patients undergoing primary rTSA using a 135° design were included. Radiographic analysis included center of rotation (COR), acromiohumeral distance (AHD), lateral humeral offset (LHO), distalization shoulder angle (DSA), lateralization shoulder angle (LSA), critical shoulder angle (CSA), and glenoid and baseplate inclination. Radiographic measurements were correlated to clinical and functional outcomes, including the American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (STT), Single Assessment Numeric Evaluation (SANE), and Visual Analogue Scale (VAS) score, active forward elevation (AFE), external rotation (AER), and abduction (AABD), at a minimum 2-year follow-up. There was a significant correlation between both DSA (r = 0.299; p = 0.020) and LSA (r = −0.276; p = 0.033) and the degree of AFE at final follow-up. However, no correlation between DSA (r = 0.133; p = 0.317) and LSA (r = −0.096; p = 0.471) and AER was observed. Postoperative AHD demonstrated a significant correlation with final AFE (r = 0.398; p = 0.002) and SST (r = 0.293; p = 0.025). Further, postoperative LHO showed a significant correlation with ASES (r = −0.281; p = 0.030) and LSA showed a significant correlation with ASES (r = −0.327; p = 0.011), SANE (r = −0.308, p = 0.012), SST (r = −0.410; p = 0.001), and VAS (r = 0.272; p = 0.034) at terminal follow-up. All other correlations were found to be non-significant (p > 0.05, respectively). Negligible correlations between pre- and postoperative radiographic measurements and clinical outcomes following primary rTSA using a 135° prosthesis design were demonstrated; however, these observations are of limited predictive value for outcomes following rTSA. Subsequently, there remains a debate regarding the ideal placement of the components during rTSA to most sufficiently restore active ROM while minimizing complications such as component loosening and scapular notching. Additionally, as the data from this study show, there is still a considerable lack of data in assessing radiographic prosthesis positioning in correlation to clinical outcomes. As such, the importance of radiographic measurements and their correlation with clinical and functional outcomes following rTSA may be limited. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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Review

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16 pages, 4055 KiB

Open AccessReview

Innovations in Shoulder Arthroplasty

by Nels Leafblad, Elise Asghar and Robert Z. Tashjian

J. Clin. Med. 2022, 11(10), 2799; https://doi.org/10.3390/jcm11102799 - 16 May 2022

Cited by 26 | Viewed by 3991

Abstract

Innovations currently available with anatomic total shoulder arthroplasty include shorter stem designs and augmented/inset/inlay glenoid components. Regarding reverse shoulder arthroplasty (RSA), metal augmentation, including custom augments, on both the glenoid and humeral side have expanded indications in cases of bone loss. In the [...] Read more.

Innovations currently available with anatomic total shoulder arthroplasty include shorter stem designs and augmented/inset/inlay glenoid components. Regarding reverse shoulder arthroplasty (RSA), metal augmentation, including custom augments, on both the glenoid and humeral side have expanded indications in cases of bone loss. In the setting of revision arthroplasty, humeral options include convertible stems and newer tools to improve humeral implant removal. New strategies for treatment and surgical techniques have been developed for recalcitrant shoulder instability, acromial fractures, and infections after RSA. Finally, computer planning, navigation, PSI, and augmented reality are imaging options now available that have redefined preoperative planning and indications as well intraoperative component placement. This review covers many of the innovations in the realm of shoulder arthroplasty. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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17 pages, 4769 KiB

Open AccessReview

Dislocation Arthropathy of the Shoulder

by Ismael Coifman, Ulrich H. Brunner and Markus Scheibel

J. Clin. Med. 2022, 11(7), 2019; https://doi.org/10.3390/jcm11072019 - 4 Apr 2022

Cited by 7 | Viewed by 3950

Abstract

Glenohumeral osteoarthrosis (OA) may develop after primary, recurrent shoulder dislocation or instability surgery. The incidence is reported from 12 to 62%, depending on different risk factors. The risk of severe OA of the shoulder following dislocation is 10 to 20 times greater than [...] Read more.

Glenohumeral osteoarthrosis (OA) may develop after primary, recurrent shoulder dislocation or instability surgery. The incidence is reported from 12 to 62%, depending on different risk factors. The risk of severe OA of the shoulder following dislocation is 10 to 20 times greater than the average population. Risk factors include the patient’s age at the first episode of instability or instability surgery, bony lesions, and rotator cuff tears. For mild stages of OA, arthroscopic removal of intraarticular material, arthroscopic debridement, or arthroscopic arthrolysis of an internal rotation contracture might be sufficient. For severe stages, mobilization of the internal rotation contracture and arthroplasty is indicated. With an intact rotator cuff and without a bone graft, results for anatomical shoulder arthroplasty are comparable to those following primary OA. With a bone graft at the glenoidal side, the risk for implant loosening is ten times greater. For the functional outcome, the quality of the rotator cuff is more predictive than the type of the previous surgery or the preoperative external rotation contracture. Reverse shoulder arthroplasty could be justified due to the higher rate of complications and revisions of non-constrained anatomic shoulder arthroplasties reported. Satisfactory clinical and radiological results have been published with mid to long term data now available. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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Other

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12 pages, 93267 KiB

Open AccessBrief Report

Current Concepts in Humeral Component Design for Anatomic and Reverse Shoulder Arthroplasty

by Joaquin Sanchez-Sotelo

J. Clin. Med. 2021, 10(21), 5151; https://doi.org/10.3390/jcm10215151 - 2 Nov 2021

Cited by 11 | Viewed by 4068

Abstract

The history of humeral component design has evolved from prostheses with relatively long stems and limited anatomic head options to a contemporary platform with short stems and stemless implants with shared instrumentation and the ability to provide optimal shoulder reconstruction for both anatomic [...] Read more.

The history of humeral component design has evolved from prostheses with relatively long stems and limited anatomic head options to a contemporary platform with short stems and stemless implants with shared instrumentation and the ability to provide optimal shoulder reconstruction for both anatomic and reverse configurations. Contemporary humeral components aim to preserve the bone, but they are potentially subject to malalignment. Modern components are expected to favorably load the humerus and minimize adverse bone reactions. Although there will likely continue to be further refinements in humeral component design, the next frontiers in primary shoulder arthroplasty will revolve around designing an optimal plan, including adequate soft tissue tension and providing computer-assisted tools for the accurate execution of the preoperative plan in the operating room. Full article

(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)

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